FURP.ORG / PUBLIC DATA EXPLORER

KENMORE MERCY HOSPITAL: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
KENMORE MERCY HOSPITAL (EIN 16-0762843)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-14
IRS object ID
201123189349301967
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-11-14T10:15:38-06:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN160762843EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Kenmore Mercy HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlKENMNameControl
Phone7168282993Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1515 Abbott Road No 500AddressLine1
CityBuffaloCity
StateNYState
ZIP Code142202039ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDavid P MacholzName
TitleVP, Finance/Corp ControllerTitle
Phone7168282974Phone
Date Signed2011-11-14DateSigned
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJoseph D McDonaldNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12121 Main StreetAddressLine1
CityBuffaloCity
StateNYState
ZIP Code14214ZIPCode
FieldValueIRS element (for citing)
Gross Receipts142334900GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.chsbuffalo.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1957YearFormation
State Legal DomicileNYStateLegalDomicile
Activity Or Mission DescriptionThe Catholic Health System (CHS) Mission is to provide quality healthcare Services in an acute care setting. Committed to a common mission, CHS providers continue the healing ministry of Jesus, seeking to improve the health of individuals and communities. We provide high quality service that has reverence, compassion, justice, and excellence. The 2010 Community Service Plan can be found at www.chsbuffalo.orgActivityOrMissionDescription
Nbr Voting Members Governing Body20NbrVotingMembersGoverningBody
Nbr Independent Voting Members6NbrIndependentVotingMembers
Total Nbr Employees1070TotalNbrEmployees
Total Nbr Volunteers304TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1005438ContributionsGrantsPriorYear
Contributions Grants Current Year673671ContributionsGrantsCurrentYear
Program Service Revenue Prior Year137432128ProgramServiceRevenuePriorYear
Program Service Revenue CY140020393ProgramServiceRevenueCY
Investment Income Prior Year120004InvestmentIncomePriorYear
Investment Income Current Year159371InvestmentIncomeCurrentYear
Other Revenue Prior Year1132513OtherRevenuePriorYear
Other Revenue Current Year1481465OtherRevenueCurrentYear
Total Revenue Prior Year139690083TotalRevenuePriorYear
Total Revenue Current Year142334900TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year70199337SalariesEtcPriorYear
Salaries Etc Current Year73913119SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year66266820OtherExpensePriorYear
Other Expenses Current Year69468565OtherExpensesCurrentYear
Total Expenses Prior Year136466157TotalExpensesPriorYear
Total Expenses Current Year143381684TotalExpensesCurrentYear
Revenues Less Expenses Prior Year3223926RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-1046784RevenuesLessExpensesCY
Total Assets BOY91718201TotalAssetsBOY
Total Assets EOY93746757TotalAssetsEOY
Total Liabilities BOY71675411TotalLiabilitiesBOY
Total Liabilities EOY74848782TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY20042790NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY18897975NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionThe Catholic Health System (CHS) Mission is to provide quality healthcare services in an acute care setting. Committed to a common mission, CHS providers continue the healing ministry of Jesus, seeking to improve the health of individuals and communities. We provide high quality service that has reverence, compassion, justice, and excellence. The 2010 Community Service Plan can be found at www.chsbuffalo.org.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense76120601Expense
Revenue100187937Revenue
DescriptionInpatient surgical services provided 2,590 I/P surgery visits, 560 visits for G.I. Lab, and 117 visits for urology. Inpatient Surgical services provides 34,126 acute care patient days and 4,681 medical rehab service days. The Skilled Nursing Facility provided 56,272 days of care.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense28871322Expense
Revenue37999676Revenue
DescriptionOutpatient surgical services provides 3,467 outpatient surgery vistits, 4,379 G.I. visits, 1,831 Interventional Radiology visits and 178 Transfusion visits. Outpatient services also provided 21,122 ED visits and 89,273 Referred Ambulatory visits.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense1392507Expense
Revenue1832780Revenue
DescriptionPrimary Care Centers and Clinics provided 29,997 visits.Description
FieldValueIRS element (for citing)
Total Program Service Expense106384430TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached0FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account1EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization1BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109688NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees1070NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Form8899 Filed0Form8899Filed
Excess Business Holdings0ExcessBusinessHoldings
Taxable Distributions0TaxableDistributions
Distribution To Donor0DistributionToDonor
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members20NbrVotingGoverningBodyMembers
Number Independent Voting Members6NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1David P Macholz VP FinanceCorporate ControllerBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7168282974TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1515 Abbott RoadAddressLine1
CityBuffaloCity
StateNYState
ZIP Code142202039ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (35 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
Joseph McDonald
President and CEO, CHS37.50XX0108869634591
Mark Sullivan
Executive VP/COO37.50XX045470323394
James Millard
President & CEO, Kenmore Mercy37.50XX2837850107952
David Macholz
Treasurer37.50XX021302624885
Brian Beitz
Director1.00X000
Peter Bergmann
Director37.50X054069822696
Frances Crosby
Director1.00X000
Richard Curran
Director1.00X000
Dennis Dombek
Director1.00X000
Michael Edbauer
Director25.00X026322628072
Christine Kluckhohn
President & CEO of Continuing Care37.50X028239480000X
William Lawley
Director1.00X000
James Manzella
Director1.00X000
Dr Paul Mason
Director1.00X2500000
Dr David Serra
Director1.00X000
Cynthia Zane
Director1.00X000
Monsignor Robert E Zapfel
Director1.00X000
Michael Montante
Director1.00X000
Dr Carlos Santos
Director1.00X0499130
Charles J Urlaub
Director37.50X039046628411
James A Dunlop Jr
Executive VP, Finance/CFO37.50X041817069366
Dr Brian D'Arcy
Senior VP, Medical Affairs37.50X059329536492
Walter Ludwig
Chief Operating Officer37.50X173166015934
Michael Moley
Sr VP Human Resources37.50038679432632X
John Stavros
Sr VP Marketing/PR37.50023781136530X
Maria Foti
Senior VP of Planning37.50022040018990X
Bartholomew Rodrigues
Sr. VP of Mission Integration37.50020926126510X
Dr Michael Galang
Chief Information Officer37.50032284718981X
Dr James Fitzpatrick
VP Medical Affairs37.50170307027616X
Dr Semira Khawar
Physician37.50149388015143X
Dr Avtar Samra
Physician37.50140389027645X
Dr Ayesha Butt
Physician37.50136014016332X
Cheryl Hayes
VP, Patient Care Services37.50134588011797X
K David Crone
Former Sr. VP Strategics Services0.00028973539608X
John Davanzo
Former Sr. VP Regional Develop0.00029131547854X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1212637TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs6252750TotalReportableCompFrmRltdOrgs
Total Other Compensation791431TotalOtherCompensation
Number Individuals GT100 K39NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Elder Medical Services PC
132 Cayuga Rd Suite 1CCheektowagaNY14225Medical Services564060
Buffalo Niagara Hospitalists LLC
2950 Elmwood AveKenmoreNY14217Medical Services422500
Sodexho Operations LLC
60 Grider StreetBuffaloNY14215Laundry Service357610
R & P Oakhill Development LLC
3556 Lakeshore Rd Suite 620BuffaloNY14219Construction Service345373
Seton Imaging
3730 Sheridan DrAmherstNY14226Medical Services312800
FieldValueIRS element (for citing)
Number Of Contractors GT100 K14NumberOfContractorsGT100K
All Other Contributions673671AllOtherContributions
Total Contributions673671TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Patient Service Revenu9000997036711670367116
Medicare/Medicaid9000996965327769653277
FieldValueIRS element (for citing)
Total Program Service Revenue140020393TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column156225TotalRevenueColumn
Exclusion$156,225ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real287317Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real287317Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column287317TotalRevenueColumn
Exclusion$287,317ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other3146Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other3146Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column3146TotalRevenueColumn
Exclusion$3,146ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
Shared Services900099658319$658,319
Cafeteria900099252618$252,618
Phone & Television90009928453$28,453

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column254758TotalRevenueColumn
Exclusion$254,758ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue1194148TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column142334900TotalRevenueColumn
Related Or Exempt Function Income140020393RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$1,640,836ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total481951Total
Management And General481951ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total57731762Total
Program Services41235335ProgramServices
Management And General16496427ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total2536684Total
Program Services1796845ProgramServices
Management And General739839ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total9716725Total
Program Services6882784ProgramServices
Management And General2833941ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total3445997Total
Program Services2440951ProgramServices
Management And General1005046ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total32659Total
Program Services32659ProgramServices

Advertising Advertising

FieldValueIRS element (for citing)
Total78390Total
Program Services57130ProgramServices
Management And General21260ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total36925971Total
Program Services36506861ProgramServices
Management And General419110ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total139986Total
Program Services19787ProgramServices
Management And General120199ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total2324787Total
Program Services376613ProgramServices
Management And General1948174ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total19729Total
Program Services13506ProgramServices
Management And General6223ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total15815Total
Program Services12791ProgramServices
Management And General3024ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total1351805Total
Program Services1351805ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total5980258Total
Program Services3443660ProgramServices
Management And General2536598ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1058980Total
Program Services687892ProgramServices
Management And General371088ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Purchase Services998570048454535140247
Professional Fees426061421577612102853
Bad Debt33281883328188
Shared Service and Dues11255731125573

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total2840110Total
Program Services1194409ProgramServices
Management And General1645701ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total143381684Total
Program Services106384430ProgramServices
Management And General36997254ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY17279252BOY
EOY15738719EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY16932804BOY
EOY19476223EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY439512BOY
EOY1454156EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1167739BOY
EOY1385720EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis92367805LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec48498120LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY44463223BOY
EOY43869685EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY11435671BOY
EOY11822254EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY91718201BOY
EOY93746757EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY18446551BOY
EOY20746095EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY14182666BOY
EOY13318952EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY12131192BOY
EOY11520986EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY26915002BOY
EOY29262749EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY71675411BOY
EOY74848782EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY19969384BOY
EOY18746304EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY73406BOY
EOY151671EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY20042790BOY
EOY18897975EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY91718201BOY
EOY93746757EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-1046784ReconcilationRevenueExpenses
Reconcilation Other Changes-98031ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed0FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis235852InvestmentCostOrOtherBasis
Book Value235852BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis57578029InvestmentCostOrOtherBasis
Depreciation34129813Depreciation
Book Value23448216BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Investment Cost Or Other Basis6570316InvestmentCostOrOtherBasis
Depreciation1092378Depreciation
Book Value5477938BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis19933153InvestmentCostOrOtherBasis
Depreciation12912530Depreciation
Book Value7020623BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis8050455InvestmentCostOrOtherBasis
Depreciation363399Depreciation
Book Value7687056BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings43869685TotalOfBookValueLandBuildings

Other Assets OtherAssets (5 entries)

DescriptionDescriptionBook ValueBookValue
Other Receivables659436
Interest in net assets of KMH Foundation3541132
Due from Affiliates1510280
Assets Limited as to use5954374
Other Assets157032
FieldValueIRS element (for citing)
Total Book Value Other Assets11822254TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (5 entries)

DescriptionDescriptionAmountAmount
Long Term portion of Insurance Liabilities$4,625,841
Interest Rate Swap$1,193,040
Due to Affiliates$2,097,753
Pension Obligation$21,217,161
Asset Retirement Obligation$128,954
FieldValueIRS element (for citing)
Total Of Amounts29262749TotalOfAmounts
Total Revenue142334900TotalRevenue
Total Expenses143381684TotalExpenses
Excess Or Deficit For Year-1046784ExcessOrDeficitForYear
Other-$573,671OtherAmount
Total Adjustments-573671TotalAdjustments
Excess Or Deficit Per FS-1620455ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt141761229TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal141761229RevenueSubtotal
Other Revenues Not Included573671OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt573671RevenueNotRptdOnFinStmt
Total Revenue Per Form990142334900TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt143381684TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal143381684ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form990143381684TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierExplanationExplanation
Part XI, Line 8 - Other Adjustments:Contributions from Foundation -573,671.
Part XII, Line 4b - Other Adjustments:Contributions from Foundation 573,671.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare

Other Percentage OtherPercentage

FieldValueIRS element (for citing)
OtherXOther
Free Other Percentage110.000000000000FreeOtherPercentage
FieldValueIRS element (for citing)
FPG Reference Discounted Care1FPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage500.000000000000DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense1425490TotalCommunityBenefitExpense
Direct Offsetting Revenue193030DirectOffsettingRevenue
Net Community Benefit Expense1232460NetCommunityBenefitExpense
Percent Of Total Expense0.00860PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense10246818TotalCommunityBenefitExpense
Direct Offsetting Revenue7008622DirectOffsettingRevenue
Net Community Benefit Expense3238196NetCommunityBenefitExpense
Percent Of Total Expense0.02260PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense11672308TotalCommunityBenefitExpense
Direct Offsetting Revenue7201652DirectOffsettingRevenue
Net Community Benefit Expense4470656NetCommunityBenefitExpense
Percent Of Total Expense0.03120PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense450229TotalCommunityBenefitExpense
Net Community Benefit Expense450229NetCommunityBenefitExpense
Percent Of Total Expense0.00310PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense345390TotalCommunityBenefitExpense
Net Community Benefit Expense345390NetCommunityBenefitExpense
Percent Of Total Expense0.00240PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense30036TotalCommunityBenefitExpense
Net Community Benefit Expense30036NetCommunityBenefitExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense825655TotalCommunityBenefitExpense
Net Community Benefit Expense825655NetCommunityBenefitExpense
Percent Of Total Expense0.00570PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense12497963TotalCommunityBenefitExpense
Direct Offsetting Revenue7201652DirectOffsettingRevenue
Net Community Benefit Expense5296311NetCommunityBenefitExpense
Percent Of Total Expense0.03690PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Total Community Building Expense428TotalCommunityBuildingExpense
Net Community Building Expense428NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense80037TotalCommunityBuildingExpense
Net Community Building Expense80037NetCommunityBuildingExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense80465TotalCommunityBuildingExpense
Net Community Building Expense80465NetCommunityBuildingExpense
Percent Of Total Expense0.00060PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$1,597,197BadDebtExpenseAmount
Amount Attributable To1580145AmountAttributableTo
Amount Reimbursed By Medicare30130983AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare31386659CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-1255676MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care0ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Kenmore Mercy HospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line12950 Elmwood AveAddressLine1
CityKenmoreCity
StateNYState
ZIP Code14217ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours
OtherAmbulatory Surgery, Dental O/POther

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities3NumberOfOtherFacilities

Other Facilities OtherFacilities (3 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
Ken-Ton Family Care
300 Two Mile Creek RdTonawandaNY14150Extension Clinic: Pediatric O/P, Prenatal O/P, Primary Medical Care O/P
Williamsville Diagnostic Center
400 International DriveWilliamsvilleNY14221Extension Clinic: Primary Medical Care, PT O/P, Radiology O/P, CT Scan,
McAuley Residence
1503 Military RdKenmoreNY14217Long Term Care

Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
Part I, Line 6a: The Kenmore Mercy Hospital Community Benefit Report is contained in a report prepared by the Catholic Health System.
Part I, Line 7: Costing is a full step down methodology of cost from non-revenue producing departments to revenue producing departments', with assignment of cost to individual charge items based on volume and charge amount. All patient accounts are cost with the same methodology regardless of patient type (inpatient, outpatient, emergency room, etc.) or insurance coverage (Medicare, Medicaid, private insurance, uninsured, etc.).
Part I, L7 Col(f): Bad debt expenses of $3,328,188 are included in Part IX, line 25, column (A) but subtracted when calculating the percentage in column (f).
Part II: Kenmore Mercy Hospital provided Community Building in the form of Leadership Development which improved community leadership by promoting understanding of community healthcare needs and services at various events throughout the community. Additionally Workforce Development was provided by mentoring and education to students regarding healthcare careers throughout the community.
Part III, Line 4: The amount in Part III line 2 is the actual bad debt expenses of $3,328,188 written down to cost, utilizing the Uninsured Ratio of Cost to Charges (RCC) obtained from the full step down methodology of cost described in Part 1, line 7. The amount in Part III line 3 is the estimate of bad debt from uninsured balance which is developed as follows: as policy is to write accounts to bad debt 120 days after discharge, the discharge date period of 10/1/2009 to 9/30/2010 was used to determine the population of uninsured accounts. The balance of these accounts was determined and the RCC was applied to develop the estimate in H Part III Line 3. As our determination of eligibility for the Healthcare Assistance Program (HAP) (Charity Care) is based solely on the presentation for care without insurance, which is now for each account, and use of a sophisticated estimator (PARO) of each guarantor's ability to pay an estimate of "the amount that reasonably could be attributable to patients who likely would qualify for financial assistance under the hospital's charity care policy if sufficient information had been available to make a determination of their eligibility" is not relevant. The organization's financial statements do not include a footnote that describes bad debt expense, but the financial statements account for bad debt expenses in the statement of operations as actual expenses written off and an estimate of future write-offs less any recoveries.
Part III, Line 8: The costing methodology used to determine the Medicare Allowable costs is Cost to Charge. The shortfall is not treated as a community benefit.
Part V, Section A: Audiology O/P, Clinic P/T Services, Clinical Laboratory Services, Coronary Care, CT Scanner, Emergency Department, Intensive Care, Medical Social Services, Health Fairs O/P, Medical/Surgical, Nuclear Medicine-Diagnostic, Nuclear Medicine-Therapeutic, Pediatric O/P, Pharmacuetical Service, Physical Medical Rehab, Physical Medicine and Rehab O/P, Primary Medical Care O/P, Radiology-Diagnostic, Renal Dialysis-Acute, Respiratory Care, PT O/P, OT O/P, and Therapy-Speech Language, Pathology
Part VI, Line 2: Kenmore Mercy Hospital, as part of Catholic Health, involves many participants in assessing community health needs including: 1. New York State Department of Health Prevention Agenda for the Healthiest State Erie County Department of Health Catholic Health Kaleida Health Erie County Medical Center Sheehan Memorial Hospital 2. Health Consumers 3. Patients/residents/clients A. Hospital Inpatients and OutpatientsB. Nursing Home Residents and Families C. Rehabilitation Patients D. Primary Care Center Patients E. Home Care Clients 4. Physicians 5. External Organizations6. Statistical Resources1. New York State Department of Health Prevention Agenda for the Healthiest State Catholic Health worked in collaboration with the Erie County Department of Health, Kaleida Health, ECMC and Sheehan Memorial on the Erie Co. DOH Prevention Agenda for the Healthiest State. In February 2009, an Erie County Joint Planning Committee formed to identify prevention priorities and strategies to focus on collaboratively over the next 3 years. 2. Health Consumers In creating the Catholic Health and Kenmore Mercy Hospital strategic plan, input was sought from a variety of constituents including consumers. In August 2008, eight (8) consumer focus groups were conducted asking consumers what they wanted from their patient care experience. These focus groups were created by reaching out to 8,000 area residents who were asked to contact friends/families/neighbors to participate. 3. Patients/residents/clients A. Hospital Inpatients and Outpatients Kenmore Mercy Hospital continues to participate in a regional patient satisfaction survey through a cooperative effort with the Buffalo Niagara Health Quality Coalition and area hospitals. Patient participation is voluntary. This survey takes place twice per year. Through hospital admission and outpatient ancillary sites, surveys were distributed to individuals to gain an understanding about their healthcare needs and how well their needs were being met. 4. Physicians Kenmore Mercy Hospital surveys its medical staff annually. Physicians are surveyed on issues relating to the quality and efficiency of services offered throughout Catholic Health including at Kenmore Mercy Hospital. 5. External OrganizationsCatholic Health and Kenmore Mercy Hospital also engaged in the P2 Collaborative (Pursuing Perfection) dedicated to improving the health of people across the region. There are more than 200 participant organizations including the provider community, payers, community based organizations, religious organizations, local business, colleges & universities, and governmental agencies. Areas of focus include working with physicians and organizations to enhance access to care and improve efficiency of care and empowering all of the Western New York community to take responsibility for and act on their own wellness.In an effort to engage health care needs at the grass roots level, Catholic Health and Kenmore Mercy Hospital work closely with the following organizations to assess community health need:Niagara Health Quality CoalitionCommunity Cancer CoalitionAmerican Heart Association Near East & West Side Task ForceBaker Victory Services Community Health Center of BuffalowNY Osteoporosis Resource Ctr.WNY Health Equity Work GroupLiving Healthy Task Force of Erie Co. Minority Health CoalitionBuffalo Public Schools Worksite WellnessFlu CoalitionEvery Parent Influences Children (EPIC)Tobacco CoalitionWNY Coalition for DiabetesCommunity Health FoundationErie Co. Coalition for DiabetesWNED Public TelevisionCatholic Charities Niagara University6. Statistical ResourcesCatholic Health and Kenmore Mercy Hospital used PQI (Preventable Quality Indicators) to map specific areas by zip code to better understand needs and target for need. We mapped specifically for Congestive Heart Failure, Hypertension, Angina & Diabetes to identify target areas for community education & screening initiatives. Other statistical resources used to assess the needs of the communities served include: "A Community Report What People Want for the Future of Healthcare in WNY""NYS Expanded Behavioral Risk Factor Surveillance System" January 2008"Buffalo Public Schools: Student Body Mass Index" 2008-2009 school year"Erie County Health Assessment Indicators" 2005-2007"Erie County Health Indicators Profile" 2003-2007
Part VI, Line 3: Kenmore Mercy Hospital informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the Catholic Health System Healthcare Assistance Program (HAP) policy. For example, Kenmore Mercy Hospital has posters and brochures available which include contact information for the Financial Clearance staff in admissions areas, emergency rooms, primary care and outpatient rehabilitation clinics, Revenue Management Center (RMC) and other areas of the organization's facilities where eligible patients are likely to be present; provides information about financial assistance and HAP contact information to patients as part of the intake process; provides financial assistance and HAP contact information to inpatients either during or within 90 days of discharge of their hospital stay; patient bills include the following language: "The Catholic Health System has a Healthcare Assistance Program to assist those in need of financial assistance for qualified patients. If you would like to obtain additional information on the Healthcare Assistance Program, please call (716) 601-3600. Thank you. Our Customer Service area is our front end team to assist all patients in this process." Additionally, we discuss with the patient the availability of various government benefits, such as Medicaid or state programs, and assist the patient with qualification for such programs, where applicable, and there is information about financial aid posted on the Catholic Health System website.
Part VI, Line 4: Kenmore Mercy Hospital serves a mostly suburban partially urban service area which is comprised of 89.1% white (non-Hispanic) and 3.8% African-American (non-Hispanic) households. The service area is more elderly than most with 19.2% of the population over the age of 65 compared to a national average of 12.9%. The community also consists of slightly fewer households than the national average with annual incomes below $15,000/year at 12.0% compared to a national average of 12.4%.Although Kenmore Mercy Hospital is not located in a designated Health Professional Shortage Area (HPSA), the hospital draws patients from other HPSAs in the region and one of its extension clinics is in a designated HPSA area.
Part VI, Line 6: Catholic Health System's community service activities at the acute facilities include benefits to the broader community, which include non-billed services and provided services paid below costs. Charity care and benefits to the community are provided through long term care facilities, home care programs and Catholic Health system-wide community programs. These programs touch more than 40,000 Western New York residents through community health eduaction programs, health screenings, clinical and support services, clerkships, internships, scholarships, in-kind donations and community support activities.The governing Board of Directors of Kenmore Mercy Hospital is comprised of community representatives from universities, legal communities, & business leaders. Religious orders are represented, as well as active and retired medical staff members.The Kenmore Mercy Hospital medical staff can be considered and "open" medical staff, as any physician can apply for privileges. Each application is reviewed by a vigorous credentialing verification process.
Part VI, Line 7: Kenmore Mercy Hospital is affiliated with the Catholic Health System, Inc., a New York State licensed corporation. Catholic Health System, located in Buffalo, New York is exempt from taxation and is a charitable organization described in Section 501(c) (3) of the Internal Revenue Code of 1986. Catholic Health is also the parent company of the following New York State corporations: Mercy Hospital of Buffalo, Sisters of Charity Hospital, Father Baker Manor, St. Elizabeth's Home of Lancaster, St. Francis Home of Williamsville, and St. Vincent's Home for the Aged, and Our Lady of Victory Senior Neighborhood.
NYReports Filed With StatesPart VI, Line 7

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment1SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org1CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs1CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (22 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Joseph McDonald
0582249021444802919990192550153360112328700
Mark Sullivan
033490008684603295709990013404047809700
James Millard
205604039478038703098184097680391737000
David Macholz
016421902358602522107091017794023791100
Peter Bergmann
0335855016739303745006055016641056339400
Michael Edbauer
018909204275003138408397019675029129800
Christine Kluckhohn
0202356047107032931063114016886036239400
Charles J Urlaub
0277509040866072091013640014771041887700
James A Dunlop Jr
0303923081292032955053504015862048753600
Dr Brian D'Arcy
02447150276792071788020231016261062978700
Walter Ludwig
1422730003089307040152300189100000
Michael Moley
0249731058450078613018611014021041942600
John Stavros
0158915039533039363017862018668027434100
Maria Foti
015555403183503301101266706323023939000
Bartholomew Rodrigues
0136513034256038492010610015900023577100
Dr Michael Galang
025667403532703084601405404927034182800
Dr James Fitzpatrick
15273401699005830126440149720197923000
Dr Semira Khawar
1392720100000116000151430164531000
Dr Avtar Samra
129561000108280123690152760168034000
Dr Ayesha Butt
1359170009704510158810152346000
K David Crone
024390600045829029157010451032934300
John Davanzo
0155588058579077148036050011804033916900

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
Part I, Lines 4a-bCertain Officers and Key employees participated in a supplemental nonqualified retirement plan per the terms and conditions of their employment arrangement. Pension Gap CHE SERP Joseph Mcdonald $26,000 $114,535 Dr Brian D'Arcy $9,800 K. David Crone $17,000 John Davanzo $16,875 Michael Moley $20,697
Part I, Line 6The 2010 Incentive payments were dependent upon achieving the Catholic Health System Operating Income target for Catholic Health System participants or the Ministry Operating Income target for Ministry participants. Joseph McDoanld $214,448 Mark Sullivan $86,846 James A. Dunlop, Jr. $81,292 John Davanzo $58,579 Michael Moley $58,450 Christine Kluckhohn $47,107 John Stavros $39,533 Dr Michael Galang $35,327 Bartholonew Rodrigues $34,256 Maria Foti $31,835 Peter Bergmann $72,559 Dr. Brian D'Arcy $60,504 Michael Edbauer, M.D $57,000 Charles Urlaub $40,866 James Millard $39,478 David Macholz $23,586 Dr. James Fitzpatrick $16,990

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1Dormitory Authority of the State of New YorkBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN146000293IssuerEIN
CUSIP Number64983Q5T2CUSIPNumber
Date Issued2006-11-29DateIssued
Issue Price16730000IssuePrice
Description Of PurposePart VDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds16730000TotalProceeds
Issuance Costs From Proceeds657688IssuanceCostsFromProceeds
Credit Enhancement99008CreditEnhancement
Capital Expenditures15973304CapitalExpenditures
Year Of Subst Completion1998YearOfSubstCompletion
Current Refunding1CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue1VariableRateIssue
Hedge Identified In Books And Recds1HedgeIdentifiedInBooksAndRecds

Name Of Hedge Provider NameOfHedgeProvider

FieldValueIRS element (for citing)
Business Name Line1JP Morgan ChaseBusinessNameLine1
Business Name Line2NABusinessNameLine2
FieldValueIRS element (for citing)
Term Of Hedge15.500000000000TermOfHedge
Superintegrated Hedge1SuperintegratedHedge
Hedge Terminated0HedgeTerminated
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (8 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
Susan Urlaub
Wife of Mercy CEO, C.J. Urlaub74933Corporate Nurse Educator0
Kathryn B Millard
Daughter of BOD, CEO Kenmore Mercy, James Millard14519Registered Nurse, Mercy0
James Manzella
Acute Care Board Member165088Key Employee of Manzella Marketing0
David Zapfel
Brother of BOD, Msgr. Robert Zapfel60600HR Employee of CHS0
Kathleen Moley
Daughter of Key Employee, Michael Moley37518HR Employee, CHS0
Kathleen Zapfel
Sister-in-Law of BOD, Msgr. Robert Zapfel53088HR Employee, St. Francis0
Susan Gallagher-Stavros
Wife of Key Employee, John Stavros35158Community Health Nurse, McAuley Seton Home Care0
Marie Packard
Daughter of BOD, Dennis Dombek42975Physical Therapist0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
Form 990, Part VI, Section A, line 6CHS has three members: Ascension Health, Catholic Health East, and the Diocese of Buffalo, NY. Each member is able to participate equally in electing the governing body, approving significant decisions of the governing body, and in receiving a share of net assets upon dissolution, according to the CHS Bylaws.
Form 990, Part VI, Section A, line 7aAccording to the CHS Bylaws, each member is equally allowed to appoint up tp three individuals to act as its representatives on the Corporate Member Board, and in undertaking any action in its capacity as a Member. The Corporate Member Board oversees the governance of the Catholic Health System.
Form 990, Part VI, Section A, line 7bEach member is entitled to one vote on each matter properly submitted at any membership meeting, and the members also have reserve powers which allow approval for certain business events and ratification of certain business transactions.
Form 990, Part VI, Section B, line 11Yes, an electronic copy of the Form 990 was provided to the CHS Boards of Directors before it was filed. The CHS Board of Directors has delegated the responsibility to review the 990 to the Audit Committee. The CHS Audit Committee reviewed in detail selected information for all CHS entities. Reviewed with the Audit Committee: 1. Core Form Part IV: Checklist of required schedules 2. Core Form Part VI: Governance, Management and Disclosure 3. Core Form Part VII: Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors 4. Schedule H: Hospitals 5. Schedule K: Supplemental information on Tax Exempt Bonds 6. Schedule J: Compensation Information 7. Schedule L: Transactions with Interested Persons 8. Schedule R: Related Organizations and Unrelated Partnerships 9. Process for which remaining Core Form was completed, utilizing audited financial information
All associates on the Merit program, all Physicians and Non Physician Practitioners as well as Physician groups who are independent contractors or employees of CHS, and all board members must complete a Conflict of Interest Disclosure Statement (COIDS) in order to fulfill the annual requirements. COIDS are distributed to all parties, as per applicable policy, and once complete are followed up with as follows: 1. Associate and Physician completed COIDS are reviewed and signed off by the manager. If a disclosure is noted, it is discussed with the manager, and the document is forwarded to the Compliance Officer who reviews and follows up as appropriate. Once review/follow up is completed the Compliance Officer will sign the COIDS, maintain a copy in the compliance office and return the original to HR for filing in the Personnel file. 2. All board member COIDS are returned to Compliance Officer for review and follow up as warranted. The Compliance Officer will sign each COIDS and retain on file in the compliance office in a confidential mannerForm 990, Part VI, Section B, line 12c
In 2010, the Catholic Health System utilized a Compensation Committee of the Board of Directors to monitor the Executive Compensation as per the Executive Compensation Philosophy and Strategy for the CHS CEO; COO; CFO; CEOs for each Ministry; and all Senior Vice Presidents. The Compensation Committee provides oversight to management decisions which are based on outlines approved by the committee, and performs a review of data. The outcome of these meetings is documented.Form 990, Part VI, Section B, line 15
We make our form 990 open for public inspection upon request. Our website includes an annual report which includes selected financial information. Our financial statements, governing documents and conflict of interest policy are provided upon request according to applicable federal and state laws.Form 990, Part VI, Section C, line 19
Changes in Net Assets or Fund Balances:Change in unrestricted interest in KMH Foundation, Inc. $479,565 Change in Pension Obligation $(1,871,236) Distribution from parent $1,405,384 Change in unrealized loss on interest rate swap $(190,008) Change in temporarily restricted interest in KMH Foundation,Inc. $78,265Form 990, Part XI, line 5:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (17 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Catholic Health System Inc
515 Abbott RdBuffaloNY14220222565278Healthcare Delivery SystemNY501cScedule A line 10
Mercy Hospital Of Buffalo
565 Abbott RdBuffaloNY14220160756336Acute Care HospitalNY501cScedule A Line 30Catholic Health System Inc
Sisters Of Charity Hospital
2157 Main StreetBuffaloNY14214160743187Acute Care HospitalNY501cScedule A Line 30Catholic Health System Inc
Nazareth Home of the Franciscan Sisters
291 North StreetBuffaloNY14201160813142Skilled Nursing FacilityNY501CScedule A line 10Catholic Health System Inc
ST Clare Manor
543 Locust StreetLockportNY14094160782647Skilled Nursing FacilityNY501cScedule A line 10Catholic Health System Inc
St Elizabeth Home for Aged
5539 BroadwayLancasterNY14086160743154Adult HomeNY501cScedule A line 10Catholic Health System Inc
St Francis Home of Williamsville
147 Reist StreetWilliamsvilleNY14221160743153Skilled Nursing FacilityNY501cScedule A line 10Catholic Health System Inc
St Francis of Buffalo Inc
34 Benwood AveBuffaloNY14214161523535Skilled Nursing FacilityNY501cScedule A line 10Catholic Health System Inc
St Joseph Manor
2211 West State StreetOleanNY14760160796400Skilled Nursing FacilityNY501cScedule A line 90Catholic Health System Inc
St Luke Manor for the Chronically Ill
17 Wiard StreetBataviaNY14020160794811Skilled Nursing FacilityNY501cScedule A line 10Catholic Health System Inc
St Mary's Manor
515 6th StreetNiagara FallsNY14301160924139Skilled Nursing FacilityNY501cScedule A line 10Catholic Health System Inc
St Vincent Manor
319 Washington AveDunkirkNY14048160743167Adult HomeNY501cScedule A line 10Catholic Health System Inc
WNY Catholic Long Term Care Inc
6400 Powers RdOrchard ParkNY14127161434368Skilled Nursing FacilityNY501cScedule A line 10Catholic Health System Inc
Niagara Homemakers Services(Mercy Homecare)
2875 Union Rd Suite 14CheektowagaNY14227161317960Home Care ProviderNY501cScedule A line 10Catholic Health System Inc
McAuley Seton Home Care
2875 Union Rd Suite 14CheektowagaNY14227161310062Home Care ProviderNY501cScedule A line 10Catholic Health System Inc
Catholic Health System Infusion Pharmacy Inc
2875 Union Rd Suite 14CheektowagaNY14227200198518Home Care Infusion ServicesNY501cScedule A line 10Catholic Health System Inc
CHS Program of All-Inclusive Care for the Elderly Inc
55 Melroy AveLackawannaNY14218261252884All-inclusive Care for the ElderlyNY501cScedule A line 30Catholic Health System Inc
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg